Cushings in a cat

RE: Cushings in a cat

shanley barber — Sun, 22 May 2016 20:29:05 GMT

I've had one Cushingoid cat that presented for its vaccination, but the hair coat was horrible! it looked like an uncontrolled diabetic. It had an abdominal mass, which my colleague removed with some difficulty, which came back as an adrenal adenocarcinoma. It has been on Florinef ever since, and low dose Pred.

i think the only obvious abnormality on the bloods was a stress leukogram and mild hyperglycaemia, if I recall correctly.

Hope that helps,

Shanley

RE: Cushings in a cat

Utlendigur — Sat, 21 May 2016 19:11:25 GMT

[quote user="Christopher Saul"] I have seen confirmed cases of cushing's in dogs without any increases of ALP at all just to complicate the picture[/quote]

Or 'steroid treatment -I had my own dog on immunosuppressive dose of preds - ALP stayed completely normal.

RE: Cushings in a cat

Christopher Saul — Sat, 21 May 2016 18:04:05 GMT

[quote user="Utlendigur"]Isn't it only dogs that have the steroid-induced ALP anyway?[/quote]

yes you're right, but ALP can be increased because of the effects of 'steroid hepatopathy' as well as due to direct induction. In the opposite direction, I have seen confirmed cases of cushing's in dogs without any increases of ALP at all just to complicate the picture (i.e you can get cushing's cases with or without ALP increases in either species).

RE: Cushings in a cat

Kate Richardson — Sat, 21 May 2016 11:22:32 GMT

[quote user="Neil Wheadon"] Have you seen any Cushings cases Kate? How did they present?[/quote]

Only seen one and was a poorly controlled diabetic, very erratic glucose levels as per Noweia's case. Thin skin, pot belly, and voracious appetite and pupd, even when glucose levels were eventually managed.

[quote user="Utlendigur"]Isn't it only dogs that have the steroid-induced ALP anyway?[/quote]

Yes, cats don't get this in the same way, however ALKP is often elevated in feline HyperA cases.

[quote user="Martin Atkinson"][quote user="Neil Wheadon"]Feeling slightly daft even agreeing to the Cushings comment in light of the eosinophils.[/quote]No need we all miss the gorilla on the stage occasionally. We could all be wrong though common things do tend to occur commonly.[/quote]

Absolutely, and cat's don't read the book either. Also not impossible to have concurrent illnesses, the pupd isn't typical of GIT disease, so makes me suspicious of a concurent illness, so would put HyperA on the list, but perhaps lower down

RE: Cushings in a cat

Utlendigur — Sat, 21 May 2016 08:18:55 GMT

[quote user="Noweia"]as ALKP wasn't elevated [/quote]

Isn't it only dogs that have the steroid-induced ALP anyway?

RE: Cushings in a cat

Noweia — Fri, 20 May 2016 23:06:41 GMT

We have one Cushing's cat on the go, it presented with marked PUPD and some weight loss. Blood glucose measurements varied wildly every time from just above normal to over 30, and as ALKP wasn't elevated we didn't twig that it was Cushings and referred it!

Not long afterwards we had another cat present with skin wounds, it had the skin hyperfragility and we had to euthanase it as a tiny bit of traction would rip the skin open. Odd to get two Cushings cats so close together after not having any up til now!

RE: Cushings in a cat

Jenny Boyd — Fri, 20 May 2016 21:07:19 GMT

Not had cushings ever in a cat but believe most present with diabetes.

With a marked eosinophilia I believe it can be secondary to neoplasia espec MCT and lymphoma. HES syndrome can be a paraneoplastic syndrome in T cell lymphoma

RE: Cushings in a cat

Utlendigur — Fri, 20 May 2016 20:07:49 GMT

[quote user="Martin Atkinson"]AFAIR urine cortisol is not reliable in cats but may be wrong[/quote]

I thought urinary cortisol creatinine ratio was useful as a rule-out for cushings, but a "positive" test was not diagnostic for cushings. I think that was what I was told by idexx (it was a few years ago - bald cat with pot belly and intermittent neuro signs)

RE: Cushings in a cat

Martin Atkinson — Fri, 20 May 2016 18:50:49 GMT

[quote user="Neil Wheadon"]Feeling slightly daft even agreeing to the Cushings comment in light of the eosinophils.[/quote]No need we all miss the gorilla on the stage occasionally. We could all be wrong though common things do tend to occur commonly.

RE: Cushings in a cat

Neil Wheadon — Fri, 20 May 2016 17:53:43 GMT

Thanks

Feeling slightly daft even agreeing to the Cushings comment in light of the eosinophils. I did check the skin and it was normal thickness.

Bloods were retaken and a fresh smear so the pathologist can look at the white blood cells better. I'll post these next week as it's an interesting case.

The owner does not want any aggressive diagnosis as a friend's cat went through the mill with multiple tests and it didn't end well (that's another discussion)

Have you seen any Cushings cases Kate? How did they present?

Thanks

Neil

RE: Cushings in a cat

Kate Richardson — Fri, 20 May 2016 16:35:34 GMT

Polyphagia is commonly associated with intestinal lymphoma, but other intestinal disease will cause it if causing any malabsorption/maldigestion, so IBD/eosinophilic enteritis as well, also consider EPI, but usually have weight loss and voluminous pale faeces as well. Hyperadrenocorticism also commonly causes a pot bellied appearance and thin skin/alopecia. As others have mentioned, eosinopenia is usually associated with HyperA, not an eosinophilia.

In view of the polydipsia, you really need to assess a urine sample, it may be unrelated to the ployphagia (thinking concurrent renal disease/PKD, may have been polydipsic for a while?) Urea is elevated whilst creat is normal, so need to determine if pre renal or renal. I don't think a urine cortisol:creat ratio will be that helpful other than a negative will rule out HyperA.

Otherwise next step for me would be an abdominal ultrasound (and double checking on parasite control)

RE: Cushings in a cat

Neil Wheadon — Fri, 20 May 2016 13:59:31 GMT

[quote user="Sammy82"]Is it truely polyphagic[/quote]

Yes very sensible owner. Eats it's food, steals the other cats food and looking for more (on the work surfaces)

[quote user="Sammy82"]is this a new thing?[/quote]

yes

[quote user="Sammy82"]How is the cats weight compared to food intake, losing/gaining?[/quote]

I weighed it and has gained 140 grams in the last 2 weeks.

Neil

RE: Cushings in a cat

Neil Wheadon — Fri, 20 May 2016 13:57:24 GMT

Yes there is diarrhoea (the cat has produced semi solid faeces and a little diarrhoea over the past 12 hours) and I could feel thickening throughout the intestines with a mass about 3 cm across in the abdomen and yes you're right the eosinophils are the wrong way round. (I was curious to see if anyone had ever seen Cushings in a cat)

The cat was presented to take bloods today and the owner has been trawling the internet and did ask about Cushings (yes I know, Dr Google) So I took the time to get some history and thought I'd ask

Thankyou Martin

Neil

RE: Cushings in a cat

Sammy82 — Fri, 20 May 2016 13:53:25 GMT

I never came across a cat with Cushing yet, would agree with Martin. Is it truely polyphagic, e.g. is this a new thing? My cats always steal food if they get the chance and would happily eat 3 times as much if I let them. How is the cats weight compared to food intake, losing/gaining?

RE: Cushings in a cat

Martin Atkinson — Fri, 20 May 2016 13:29:52 GMT

That eosinophil count shouts IBD at me, I can't see anything that would make me think HAC, indeed you would expect a low count so I would say that is excluded. AFAIR urine cortisol is not reliable in cats but may be wrong. What are its faeces like and any history of vomiting?

I would have it on a restricted protein/hypoallergenic diet first, then biopsies if its not improving, +/- preds if they don't want biopsies.

PS why are all values flagged with an asterisk, it makes it confusing as that normally indicates abnormal?